Background: Improved survival rates of stroke patients have resulted in a rise in disability within this population. Research demonstrates that stroke patients are at high risk for cognitive decline and depression. Neuropsychological intervention can improve outcomes for this population. At an academic medical center in the Midwest, the process in which stroke patients are screened for these impairments and subsequently referred to a neuropsychologist is ineffective.
Purpose: The purpose of this quality improvement project was to critically appraise the process in which stroke patients are screened for cognitive decline and depression and to improve the process using a multi-disciplinary approach of nursing, medicine, rehabilitation and neuropsychology.
Methods: A total of 231 patient charts were reviewed in this quality improvement project. The Plan-Do-Study-Act model was utilized. Process changes included: provider education on order placement of neuropsychology referrals, occupational therapist education on correct progress note use, and improvement of visibility of the stroke patient list to screening staff. Pre- and post-intervention data were examined to assess for changes in screening compliance and consultations.
Results: Baseline data collected December 2016 showed 64% compliance with Montreal Cognitive Assessment (MoCA) screening, 50% compliance with Patient Health Questionnaire (PHQ-2) screening, and 50% compliance with neuropsychology referral. After new processes were implemented, April 2016 data showed 100% MoCA compliance, 95% PHQ-2 compliance, and 100% neuropsychology referral compliance. Although these numbers look promising, we will continue to gather and analyze data to ensure this positive compliance trend continues.
Conclusion: Multidisciplinary education and increased visibility of stroke patients requiring a screening may increase compliance of cognitive decline and depression screening as well as subsequent referral to neuropsychology. The increase in screening compliance will ultimately lead to appropriate referrals and further resources for the stroke population.